Sebaceous carcinoma is a rare cutaneous malignancy that is most frequently found in the eyelids with an estimated risk of regional lymph node metastasis in the 8% to 14% range. The authors have previously reported the use of sentinel lymph node biopsy and microscopically positive sentinel lymph nodes in various eyelid and conjunctival cancers, including conjunctival and eyelid melanoma and Merkel cell carcinoma. The authors herein describe the first successful identification of a microscopically positive sentinel lymph node in a patient with sebaceous carcinoma of the eyelid, suggesting that sentinel lymph node biopsy for sebaceous carcinoma of the eyelid deserves further investigation.